The association of adverse childhood experiences and suicide-related behaviors among 10th grade secondary school students

The association between adverse childhood experiences and suicide-related behaviors (SRB) of adolescents has been widely studied in Western high-income countries, but not yet in Latin America. The aim of this study was to determine this association and also explore the dose-response association between adverse childhood experiences and SRB in Chile. We conducted a cross-sectional study, and we assessed adverse childhood experiences up to one year prior to the survey, suicide-related behaviors (suicide ideation in the past week and suicide attempts in the past six months) in a sample of secondary school students. Multilevel and multivariable logistic regressions were run with suicide-related behaviors as dependent and adverse childhood experiences as independent variables, adjusted by self-esteem, general mental health, friends and parental support, and the onset age of cannabis and alcohol use. We included n=7,458 adolescents (48.7% girls), mean age = 16.0 (SD = 0.7), and found a prevalence of 78.1% for at least one adverse childhood experience. The six-month prevalence of suicidal ideation was 18.1% (95% IC: 17.2-19.0), and the prevalence of suicide attempts 5.0% (95% IC: 4.6-5.6). Sexual abuse was a prominent risk factor for both suicide-related behavior. The ages of onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively. We also found an independent effect of the total number of adverse childhood experiences on suicidal ideation (p<0.001) and on suicide attempts (p<0.001). This is the first evidence of a dose-response effect of adverse childhood experiences on suicide-related behaviors in adolescents from Latin America.